HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP'LeccD FOR APPLICATION TO BE ACCEPTED i
Date: SCANNED Permit Number: 11t%I- Y)c v
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St. Lucie County [11ILu-lad
-- Building Permit Applicyr
Planning and Development Services
Building and Code Regulation Division� ®�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ R
PERMIT APPLICATION FOR:
PROPOSED NPROUEMENT LOCATION::
Address:
Legal Description: 14LOA) iz:zg�A 6d!!4
PropertyTax lD #: #--"/ -,3 3—��Dl—('7D0 r '/ Lot No.
Site Plan Name:
Project Name: �. 4,4%24 A?6-dAc—
Setbacks Front Back: Right Side: Left Side:
Block No.
_Mechanical _GAs'Tank _Gas Piping _Shutters —Windows/Doors
Electric kPlumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: la G 4 d
Cost of Construction: $ I
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Ki fiU-t-P- K(r.1-0 DO
Name: Tf/- Demo-/
Address: (Ied�o A&U60
Company:6o&-?7j'-&- -R-Pkc-� 10-4-�45�
City: State: �
Zip Code: 3 i(RP7 Fax:
Phone No. = -!79' laPi-P
Address:
City: Stater{"
Zip Code —g4f V--? Fa0'72 9— 0
Phone No /- 6�
E-Mail: 6014
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail 0,6//eJcai4!?or7-t,4SS,
State or County License'CG GD-r'k;La�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MR. PLEMENTAS@O TRUCTIRN LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:L_ BtIfLcH
MORTGAGE COMPANY: _ Not Applicable
Name:
46q
Address: /790 tul B/CTi ro2>; Si
Address:
City: On 2' ci State:
'Zip: 33�- Phone oZ —' 8S�
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:.
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wprk or recording your Notice of Commencement.
SE.,
Sig u of Owner/ Lessee/Contractor as Agent fo
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S-igb6ture of Contractor/License Holder
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STATE OF FLORIDA-
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STATE OF FLORI
COUNTY OF
COUNTY OF
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The forgoing ins ent was acknowledged before
this day o 204. by
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The for oinginstr ent wasacknowledge before
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Name of person making statement.
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Name of person making statement. a �N
Person Know OR Produced Identificati
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Personal] nown OR Produced Identification
Type of I entification
Type of Ide 'cation
Produced
Produced
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;Signature Nota Public- State Florida
(Signature cVdt-aTy Public- State o lorid )
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Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
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